title: Difficulty giving feedback on underperformance undermines the educational value of multi-source feedback.
abstract: BACKGROUND
  Multi-source feedback (MSF) was intended to provide both a summative and formative assessment of doctors' attitudes and behaviours.
  
  
  OBJECTIVE
  To explore the influences of feedback quality and trainees' acceptance of the assessment on formative educational gains from MSF.
  
  
  METHODS
  Semi-structured interviews were conducted with a convenience sample of eight dermatology trainees, from an insider researcher position, following two pilot interviews. Interviews were manually transcribed and coded to permit template analysis, a subtype of thematic analysis.
  
  
  RESULTS
  The interview data indicated that MSF provides relatively little formative educational gains largely because of a paucity of constructive feedback on sub-optimal performance. This was due to difficulties encountered by raters giving developmental feedback, in particular, potential loss of anonymity, and by trainees selecting raters expected to give favourable comments. Dual use of MSF as a summative assessment in annual appraisals also inhibited educational gains by promotion of a 'tick box' mentality in which trainees' need to pass their assessment superseded their desire for self-improvement.
  
  
  CONCLUSIONS
  A relative lack of developmental feedback limits the formative educational gains from MSF and could provide false reassurance that might reinforce negative behaviours.
authors.affiliation: Cardiff University , UK.
authors.forename: John R
authors.initials: JR
authors.lastname: Ingram
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Anderson
authors.forename: Lesley
authors.initials: L
authors.lastname: Pugsley
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D003880:Dermatology; D004501:Education, Medical / Q000379:methods*; D004521:Educational Measurement / Q000379:methods*; D005246:Feedback; D006801:Humans; D010465:Perception; D013337:Students, Medical / Q000523:psychology*